Managing Medicare

Medicare billings now reported on federal Web site

By KEVIN FREKING
THE ASSOCIATED PRESS

WASHINGTON - To help Americans become smarter health care shoppers, Medicare this month started publishing a range of what it pays for 30 common procedures and report how frequently hospitals perform them.

The release of the information fits with the Bush administration’s strategy of moving more people into health savings accounts and high-deductible insurance policies. Such insurance policies require people to bear more of their initial medical expenses.

As more people buy such policies, the administration maintains, cost increases would slow because people would work harder to look for the best deal or decide they don’t really need a medical service after all.

The Medicare data - released June 1 - covers such procedures as heart operations, the implant of heart defibrillators and back and neck operations.

The most common elective surgery paid for by Medicare is the replacement of a hip or knee. The government information shows that those procedures cost an average of $11,761. Medicare paid between $9,992-$12,173, on average.

The Pueblo Chiefton

Medicare | House Democratic Caucus Asks CMS To Help Low-Income Medicare Beneficiaries Enroll in Prescription Drug Benefit

Nearly 150 members of the House Democratic Caucus have sent a letter to CMS Administrator Mark McClellan urging him to take additional steps to enroll low-income beneficiaries in the Medicare prescription drug benefit, CQ HealthBeat reports. The letter asks CMS to take several steps, including working with the Social Security Administration to identify low-income beneficiaries who might be eligible for assistance with deductibles, premiums and copayments. Rep. Lloyd Doggett (D-Texas), a member of the House Ways and Means Subcommittee on Health, said, “The administration must make an extra effort to notify seniors entitled to extra help.” CMS spokesperson Jeff Nelligan said the agency will review the letter (CQ HealthBeat, 5/26).

Source: Kaisernetwork.org

Part D Weely Calls to Be Terminared

Since December of 2005 we have been holding weekly Part D Providers conference calls to address issues physicians and other health care providers were having with Part D. We have seen a gradual decline in the participation on those calls and this past week, we only had one question on the call. To that effect, we are going to hold the final weekly Part D Providers call on May 30th at 2pm EST.

We continue to remain committed to fixing your Part D issues and we are confident that between your email access to us

(PRIT@cms.hhs.gov) and our participation in the Open Door Forums (ODF) you will not feel abandoned. We are asking that physicians and other health care providers take their Part D issues to their respective ODF calls. If you do not currently participate in the ODFs, you are encouraged to sign up to receive the ODF announcements by going to: http://www.cms.hhs.gov/apps/mailinglists/default.asp?audience=4 or http://www.cms.hhs.gov/opendoorforums/

Again, the last Weekly Part D Providers call will occur on May 30th at 2PM EST. The next Skilled Nursing Facilities/Long-Term Care ODFs is June 6th (1-800-837-1935, Reference ID: 8266876) and the next Physician ODF is June 27th. Both will start at 2pm EST.

Senators: Extend Part D Enrollment Deadline…

New Jersey’s two U.S. senators on Monday called for the federal government to extend the May 15 deadline for senior citizens to enroll in the new Medicare prescription drug program, commonly called “Part D.”

Sens. Frank R. Lautenberg and Robert Menendez, both Democrat, said many senior citizens remain confused about the program and different prescription plans. In New Jersey, there are 19 providers offering 45 different prescription drug plans, the senators said.

Complete NorthJersey.com Story

2007 MA/MAPD Call Letter

CMS has released the 2007 MA/MAPD Call letter.  Download it here.

Payment Increases to Medicare Advantage Plans Lower

CMS on Monday said that reimbursement rates for Medicare Advantage plans in 2007 will increase by only about 1.1% on average, rather than 4% as scheduled, because of a technical adjustment of how physicians code beneficiaries for billing, CQ HealthBeat reports. According to CQ HealthBeat, past small increases in reimbursement rates have led to decreases in benefits offered by Medicare Advantage plans.

Medicare Advantage plans in most cases offer more benefits than traditional Medicare because of higher reimbursement rate increases established under the 2003 Medicare law, in addition to separate subsidies from the federal government for plans that provide prescription drug coverage.

Karen Ignagni, president of America’s Health Insurance Plans, said, “No member of Congress will be able to conclude that plans are overpaid next year.”

Capitol Hill Watch | House Budget Committee Approves FY 2007 Budget Plan Without Medicare, Medicaid Cuts

The House Budget Committee on Wednesday voted 22-17 along party lines to approve a $2.8 trillion fiscal year 2007 budget resolution that does not call for mandatory spending reductions to Medicare or Medicaid, CQ Today reports. President Bush in his budget proposal last month outlined $65 billion in spending reductions from Medicare and other mandatory programs over five years. The House resolution includes $6.8 billion in spending reductions to mandatory programs, but it “spar[es] politically sensitive programs such as Medicaid and Medicare,” CQ Today reports (Dennis, CQ Today, 3/29). Budget Committee Chair Jim Nussle (R-Iowa) and other House committee chairs “are still figuring out how to meet the $6.8 billion mandatory spending cut goal,” CongressDaily reports (Cohn, CongressDaily, 3/29). The House resolution adopts Bush’s proposed $873 billion cap on discretionary spending, which would increase 3.6% over last year (Dennis, CQ Today, 3/29). The plan includes a 7% increase in the core defense budget, not including war costs, meaning that domestic programs such as health research and education face tightened budgets (Seattle Times, 3/30). Under the discretionary spending cap, “nonsecurity spending would rise by a negligible amount for a near-freeze over FY06 levels,” CongressDaily reports (CongressDaily, 3/29).

Health Plans Don’t Fear 2007 Medicare Advantage Rates, See Positive Long Term

CMS is expected to issue final 2007 Medicare Advantage (MA) payment rates April 3. But some established Medicare managed care organizations aren’t holding their breath: They anticipate satisfactory reimbursement for next year’s MA product lines….

Visit AISHealth to read the entire story.

CMS Takes Steps To Clean Up Enrollment

Last week CMS notified Medicare prescription drug plan sponsors of the process for reconciling plan enrollments to ensure that all beneficiaries who have elected to change plans are appropriately disenrolled from their initial plan by April 30, 2006. To ensure that all enrolled beneficiaries would have access to prescription drug coverage in the early days of the new program, particularly for dual-eligible beneficiaries who switched plans later in the month, CMS advised plans in January to delay processing certain disenrollments. By early February, most plans began processing disenrollments. As a result of the January CMS instruction and some plans’ decision to continue delaying disenrollments into February or March, certain beneficiaries have had access to coverage under more than one plan: the initial plan that continued coverage, and a subsequent plan chosen by the beneficiary or an agent acting on their behalf (the Medicare “plan of record”). As the startup of the drug benefit progresses, CMS is now taking steps to ensure that all beneficiaries who changed plans are appropriately disenrolled from their initial plan by April 30, 2006. This process of reconciling plan enrollments will assure consistent coverage, allow appropriate tracking of out-of-pocket costs, permit payments to be fully reconciled between plans, and most importantly, ensure that each beneficiary continues to receive drug coverage smoothly and consistently. Please find attached a one-pager that further describes this process. The standard letters sent to affected beneficiaries on CMS letterhead are also attached for your reference.

DEADLINE: PDPs, MA-PDs, Cost, and PACE 2007 Applications

Today is the deadline for all PDPs, MA-PDs, Cost, and PACE 2007 applications.

Details on the CMS website.